Kampman et al., 2015 [27] | To observe the incidence of cardiovascular complications in the first year postpartum and to compare cardiac function parameters pre-pregnancy and 1-year postpartum in women with CHD. | 172 pregnancies in 172 women | 8 participating centers, the Netherlands | A prospective multicenter cohort study | Cardiovascular events 1-year postpartum: Women with higher modified WHO risk classifications before pregnancy had higher cardiovascular events. Of the women with cardiovascular events postpartum, 63.6% had no history of cardiovascular events before pregnancy and 71.4% developed new arrhythmia. Women with cardiovascular events during pregnancy had a higher risk of cardiovascular events postpartum compared with women without cardiovascular events during pregnancy. The incidence of cardiovascular events 1-year postpartum was 6.4%. |
Pillutla et al., 2016 [18] | To identify the cardiovascular and neonatal outcomes in pregnant women with high-risk CHD. | 61 pregnancies in 43 women | The Ahmanson/ University of California Los Angeles (UCLA) Adult Congenital Heart Disease Center (ACHDC), USA | Single-center retrospective analysis | Of all pregnancies, 31% were complicated by a cardiovascular event and that the most common cardiac events were either heart failure or arrhythmias. Development of any major cardiac complication during pregnancy was best predicted by antepartum maternal arrhythmia. |
Bowater et al., 2013 [25] | To examined whether the deterioration associated with pregnancy is due to the physiological changes of pregnancy itself, or is part of the known deterioration that occurs with time in these patients. | 31 pregnancies in 18 women | Queen Elizabeth Hospital, UK | Retrospective analysis | This study suggests that pregnancy is associated with a premature deterioration in RV function in women with a systemic RV. These women are also more symptomatic, with a greater reduction in functional class compared with patients with a systemic RV who do not undergo pregnancy. There are increased risks in comparison with the general population, with a higher preterm delivery and low birth weight rates. There is also a higher cesarean section rate in this population, 39% vs. a 23% average for the hospital. |
Assenza et al., 2013 [24] | To better understand the quantitative volumetric changes associated with pregnancy in women with repaired tetralogy of Fallot (TOF), utilizing sequential cardiovascular magnetic resonance (CMR) imaging. | 30 pregnancies in 30 women, and 26 nulliparous women (Total 56) | Boston Children’s Hospital, USA | Retrospective analysis of records | Women with repaired TOF who have completed pregnancy appear to experience an accelerated rate of right ventricular remodeling, defined as an increase in end-diastolic volume; however RV systolic function does not deteriorate. |
Ladouceur et al., 2016 [22] | To describe maternal and fetal outcomes during pregnancy in patients with PAH-CHD. | 28 pregnancies in 20 women | Seven different French centers, France | Retrospective multi-center analysis | 28 pregnancies in 20 women (26 ± 6 years old) with PAH-CHD were managed during this period. There were 18 complete pregnancies (≥20 weeks’ gestation (WG)), 8 abortions and 2 miscarriages. Six (33%) patients experienced severe cardiac events they had lower resting oxygen saturation. The most common cardiac complications during the complete pregnancies were heart failure (n = 4) and severe hypoxemia (n = 5). Heart failure was overall severe, requiring inotropic treatment in three patients, mechanical circulatory support in one and led to one maternal death (mortality = 5.0%). Obstetrical complications occurred in 25% of pregnancies. Small for gestational age was diagnosed in 39% (7/18) of fetuses. 12/18 (67%) pregnancies were delivered by caesarean section, of which 10 in emergency for obstetrical reason. Prematurity was frequent (78%), but no neonatal death occurred. |